What is the science behind creatine supplementation for older women?

If you want just the science without our analysis, read this article: https://pmc.ncbi.nlm.nih.gov/articles/PMC7998865/

The Problem

Menopause brings about profound biological changes that can deeply affect women’s health, often in ways that aren’t immediately visible but gradually impact quality of life. Two of the most significant challenges during this transition are the rapid deterioration of bone density and the depletion of cellular energy, both tied closely to the loss of estrogen. Estrogen plays a protective role in maintaining bone structure and supporting cellular energy production, but when its levels plummet after menopause, these crucial systems become destabilized.

Bone Health

Estrogen loss after menopause leads to accelerated bone density deterioration

The body maintains bone tissue through a delicate balance of two opposing processes: bone formation and bone resorption. When this balance tips, it can lead to significant bone density loss. During the post-menopausal period, the dramatic decrease in estrogen levels disrupts this equilibrium, leading to accelerated bone loss that can ultimately result in osteoporosis. But how exactly does estrogen maintain healthy bones?

The body can build new bone tissue, but without estrogen, degradation outpaces formation

Bone maintenance involves two types of specialized cells working in harmony: osteoblasts (bone-building cells) and osteoclasts (bone-breaking cells). Before menopause, estrogen helps regulate this process by supporting osteoblast activity while simultaneously keeping osteoclast activity in check. When estrogen levels plummet after menopause, this regulatory system becomes compromised. Osteoclasts become overactive, breaking down bone tissue faster than osteoblasts can rebuild it.

However, bone loss isn't uniform throughout the skeleton. Some areas, particularly those rich in trabecular bone like the spine and hip, are especially vulnerable to this accelerated deterioration. While the body still maintains some ability to form new bone tissue, the loss of estrogen's protective effects means that bone degradation occurs at a much faster rate than formation. This imbalance is the primary reason why nearly one in five women experience osteoporosis and nearly half of all women experience low bone mass.

Thus arises a clear hypothesis: If we can address the weakening of the bones that occur after menopause, we can help maintain bone health and prevent the cascade of health issues that arise from compromised bone integrity. This would be particularly beneficial for post-menopausal women who want to maintain their mobility and independence as they age.

Fatigue and Cognitive Health

Inefficient energy production and poor sleep quality contribute to fatigue and cognitive decline in post-menopausal women

In a cross-sectional study of 300 women, 85.3% of those in postmenopause reported mental or physical tiredness.

The body has many biological responses to menopause, not all of which are immediately obvious. The dramatic drop in estrogen levels triggers a cascade of cellular changes that impact how energy is produced and utilized, particularly in muscle and brain tissue. One of the major challenges is maintaining adequate ATP levels, the primary energy currency of our cells. ATP fuels countless essential processes, from muscle contractions to neurotransmitter release in the brain, so when ATP production becomes less efficient, women may experience fatigue, reduced cognitive function, and decreased physical performance. But how exactly does menopause disrupt our cellular energy systems?

The body can normally produce energy efficiently, but post-menopausal changes disrupt this process. 

When younger, cells maintain energy production through complex energy pathways, each requiring specific molecules and hormones—especially estrogen—to function at peak efficiency. Before menopause, estrogen plays a key role in regulating energy metabolism and supporting ATP production in both muscle and brain tissue. But with the onset of menopause, this energy-support system becomes compromised. While the body’s cells retain the basic machinery for ATP production, they struggle to maintain the same efficiency without estrogen’s regulatory influence.

This energy challenge goes beyond muscles. The brain, which consumes about 20% of the body’s energy, is also significantly impacted by the post-menopausal drop in ATP efficiency. Unlike muscles, which can adapt to use alternative energy sources, brain cells are particularly reliant on stable, efficient ATP production. This reduction in energy efficiency affects neural cells’ ability to support cognitive functions like memory, concentration, and clarity, which may contribute to the cognitive “fog” that many post-menopausal women report experiencing.

Thus arises a clear hypothesis: If post-menopausal women’s cells could be supported to regenerate ATP more effectively, even without estrogen, they might maintain better physical energy and mental clarity. This approach could offer a path for women to retain their vitality and cognitive sharpness well into their later years, making the post-menopausal journey one of strength and resilience.

The Solution

Creatine can enhance cellular energy production and support bone density maintenance.

If you're trying to address the energy deficit and bone density loss that occurs after menopause, the most direct approach would be to enhance the body's ability to produce energy efficiently while supporting bone tissue maintenance. The challenge is that these processes are typically regulated by estrogen, which significantly decreases after menopause. However, our cells already have natural mechanisms for energy production and bone maintenance - they just need the right support.

Scientists have discovered three crucial things about creatine:

• It exists naturally in our bodies as phosphocreatine and plays a vital role in quick energy production
• It can directly enhance ATP regeneration, providing rapid energy when cells need it most
• When combined with resistance training, it can help lessen the negative impact of low bone mineral density in post-menopausal women
• It may help reduce bone resorption when combined with resistance training

Rather than trying to replace estrogen's complex role in the body, creatine works by enhancing our existing cellular energy systems. In muscles, creatine exists as phosphocreatine, which can quickly donate phosphate groups to regenerate ATP - our cells' primary energy source.

This enhanced energy availability not only supports muscle function but also helps maintain bone density when combined with exercise.

Research has shown that adults who supplement with creatine (typically 5 grams daily) experience significant improvements in muscle strength and exercise performance. This is particularly important because stronger muscles help maintain bone density and overall physical function. 

Additionally, studies have demonstrated that creatine supplementation, especially when combined with resistance training, can help augment decreases in bone mineral density, providing a protective effect against the risk of falling or breaking bones from accelerated bone loss that typically occurs during menopause.

The result is a natural solution that works with the body's existing mechanisms to maintain energy production and support bone health during the post-menopausal period, when these systems typically begin to decline.

What is Creatine

Creatine is a naturally occurring compound essential for energy production and muscle recovery in the body. Although not an amino acid, creatine plays a vital role in enhancing energy availability, particularly within muscle tissues during high-intensity, short-duration activities. Around 95% of the body’s creatine is stored in muscles, with the rest found in the brain, liver, and kidneys.

The body synthesizes creatine in organs like the liver, kidneys, and pancreas using amino acids such as glycine, arginine, and methionine. While the body produces creatine naturally, certain foods, especially meat and fish, are also rich sources. This dietary creatine is especially important for individuals who may not consume animal products, as supplementation can help them achieve more significant muscle gains .

Creatine’s primary function is to regenerate adenosine triphosphate (ATP), the cell’s main energy carrier, during high-energy demand. When ATP is quickly used up during intense activity, creatine phosphate in muscles donates a phosphate group to ADP, rapidly replenishing ATP and allowing muscles to maintain contraction and performance.

Supporting Evidence

As part of The Next Chapter, our women’s health blog, we provide literature reviews that help explain findings in the scientific community about postmenopausal health. 

The Next Chapter

Additionally, many experts have supported the idea of creatine supplementation post menopause, like Dr. Suzanne Gilberg-Lenz, a board-certified OB-GYN and menopause specialist. 

A 2021 review of the literature published in Nutrients by Dr. Abbie Smith-Ryan reported that “creatine supplementation may be of particular importance during menses, pregnancy, post-partum, during and post-menopause”.

Dr. Stacy Sims, PHD a performance-focused physiologist and nutrition scientist has stated publicly that “[Creatine] might be the most important supplement many women still aren’t taking.”

On the mindbodygreen podcast with Jason Wachob, Dr. Darren Candow, PHD stated  “When the ovaries are not producing enough estrogen to maintain adequate physiology, this is where creatine may help rescue some of those effects”. Dr Candow has published over 125 peer-refereed journal manuscripts in the creatine health space.

For further reading, this study by Dr. Abbie Smith-Ryan is a recommended high level overview.

Alternatives

After understanding that creatine is a natural compound that helps cells produce energy quickly, particularly in muscles and the brain, it's important to explore the full range of current treatments and alternatives available to post-menopausal women.

Medical professionals typically recommend several approaches for managing post-menopausal health challenges:

Traditional Medical Treatments:

• Hormone Replacement Therapy (HRT)
• Prescription medications (bisphosphonates, denosumab, SERMs)
• Traditional calcium and vitamin D supplements
• Alternative therapies like acupuncture (BMS, Healthline, Endocrine Society)

Dietary Supplements:

• B Vitamins, especially B6 and B12, for energy metabolism
• Omega-3 fatty acids for brain health and inflammation reduction
• Vitamin D for energy, mood, and cognition (600-800 IU daily recommended)
• Soy-based supplements containing isoflavones

Herbal Supplements:

• Ginkgo Biloba for cognitive function and blood flow
• Rhodiola Rosea for fatigue and stress resistance

Lifestyle Approaches:

• Regular exercise, combining aerobic and strength training
• Balanced diet rich in whole foods and lean proteins
• Adequate sleep (7-9 hours nightly)
• Stress management techniques

However, each of these alternatives addresses only specific aspects of the complex changes women experience after menopause. HRT, while effective, requires careful medical supervision and isn't suitable for all women. Prescription medications can effectively target bone density issues but often come with significant side effects and require close monitoring.

B vitamins and omega-3s support overall health but don't directly address cellular energy production. Herbal supplements show promise but need more research to confirm their long-term effectiveness. Even the most common recommendations - calcium and vitamin D - while essential for bone health, can't help cells produce energy more efficiently or support quick energy needs.

This is where creatine's unique properties become particularly relevant. Unlike these alternatives that work through indirect pathways or require intensive medical oversight, creatine works directly with the body's existing energy production systems. It's already present in our cells and has a well-documented safety profile, offering a more straightforward approach to supporting both energy production and physical function.

However, healthcare providers emphasize that any new supplement regimen should be discussed with a medical professional. These alternatives might be appropriate in combination with or instead of creatine, depending on individual health needs and circumstances

Safety

Creatine is one of the most extensively studied supplements, with research consistently affirming its safety when used as recommended. Unlike many other supplements, creatine has undergone rigorous scientific testing, and studies indicate it is generally safe for healthy adults, making it one of the most well-tolerated supplements available .

The typical dosing protocol for creatine includes either a loading phase of 20 grams per day for 5-7 days, followed by a maintenance dose of 3-5 grams daily. This approach helps achieve optimal muscle creatine levels quickly and is commonly used in athletic and clinical settings.

While creatine is safe for most individuals, some may experience mild, manageable side effects, such as muscle cramping, dehydration, or digestive issues like nausea or diarrhea. These effects are usually minor and can often be minimized by ensuring proper hydration and adhering to dosing guidelines.

A frequently raised concern is creatine’s potential impact on kidney health. However, extensive studies have found no definitive link between creatine use and kidney damage in healthy individuals. Still, those with pre-existing kidney conditions or a history of kidney issues should consult their healthcare provider before using creatine to ensure it’s a safe option.

Here’s our literature review on kidney function, safety, and creatine: The Review: Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis 

For specific populations, additional caution is advised. For example, pregnant or breastfeeding women should avoid creatine due to limited research on its safety for these groups. However, creatine may offer particular benefits for older adults, supporting brain health, muscle mass, and overall vitality as they age.

What’s the Upshot?

As women navigate the post-menopausal phase, maintaining bone health and energy levels becomes crucial for sustaining their overall vitality and quality of life. The decline in estrogen after menopause disrupts bone density and cellular energy production, leading to challenges such as osteoporosis, fatigue, and cognitive decline. While traditional treatments like hormone replacement therapy and dietary supplements address specific symptoms, creatine offers a unique, targeted solution. By supporting ATP regeneration, creatine works directly with the body’s natural energy systems, helping post-menopausal women maintain muscle strength, cognitive clarity, and bone health. With creatine supplementation, combined with lifestyle choices like resistance training, women can manage these transitions more effectively, promoting a future of strength and resilience.

 

References

Kreider RB, Stout JR. Creatine in Health and Disease. Nutrients. 2021 Jan 29;13(2):447. doi: 10.3390/nu13020447. PMID: 33572884; PMCID: PMC7910963.

https://www.sciencedirect.com/topics/neuroscience/creatine

Candow DG, Forbes SC, Chilibeck PD, Cornish SM, Antonio J, Kreider RB. Effectiveness of Creatine Supplementation on Aging Muscle and Bone: Focus on Falls Prevention and Inflammation. J Clin Med. 2019 Apr 11;8(4):488. doi: 10.3390/jcm8040488. PMID: 30978926; PMCID: PMC6518405.

Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DG. Creatine Supplementation in Women's Health: A Lifespan Perspective. Nutrients. 2021 Mar 8;13(3):877. doi: 10.3390/nu13030877. PMID: 33800439; PMCID: PMC7998865.

Cornish SM, Candow DG, Jantz NT, Chilibeck PD, Little JP, Forbes S, Abeysekara S, Zello GA. Conjugated linoleic acid combined with creatine monohydrate and whey protein supplementation during strength training. Int J Sport Nutr Exerc Metab. 2009 Feb;19(1):79-96. doi: 10.1123/ijsnem.19.1.79. PMID: 19403955.

 Wax B, Kerksick CM, Jagim AR, Mayo JJ, Lyons BC, Kreider RB. Creatine for Exercise and Sports Performance, with Recovery Considerations for Healthy Populations. Nutrients. 2021 Jun 2;13(6):1915. doi: 10.3390/nu13061915. PMID: 34199588; PMCID: PMC8228369.

CHILIBECK, PHILIP D.1; CANDOW, DARREN G.2; GORDON, JULIANNE J.1; DUFF, WHITNEY R. D.1; MASON, RILEY1; SHAW, KEELY1; TAYLOR-GJEVRE, REGINA3; NAIR, BINDU3; ZELLO, GORDON A.4. A 2-yr Randomized Controlled Trial on Creatine Supplementation during Exercise for Postmenopausal Bone Health. Medicine & Science in Sports & Exercise 55(10):p 1750-1760, October 2023. | DOI: 10.1249/MSS.0000000000003202

https://hellogloria.com/essays/creatine-for-perimenopause-and-menopause/

Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DG. Creatine Supplementation in Women's Health: A Lifespan Perspective. Nutrients. 2021 Mar 8;13(3):877. doi: 10.3390/nu13030877. PMID: 33800439; PMCID: PMC7998865.

https://www.drstacysims.com/blog/Why%20Active%20Women%20Need%20Creatine

https://open.spotify.com/episode/2xUDoQrTu7d7Hz0dZDvcGj